What is Anal Fistula?

An anal fistula is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.

Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats.

How it works?

An anal fistula is a small tunnel that develops between the skin around the anus and the inside of the anal canal. It typically forms as a result of an anal abscess, which is a collection of pus in the tissues around the anus. The primary goal of treating an anal fistula is to eradicate the tunnel and prevent recurrence.

Treatment for an anal fistula often involves surgery. Here’s how the procedure generally works:

• Assessment and Diagnosis: The first step is to accurately diagnose the anal fistula. This usually involves a physical examination by a healthcare professional, possibly including imaging studies such as an MRI or ultrasound.
• Preparation for Surgery: Before surgery, the patient may need to undergo certain preparations, such as bowel cleansing or fasting. This helps ensure a clear surgical field and reduces the risk of infection.
• Surgical Intervention: There are several surgical techniques used to treat anal fistulas. The choice of technique depends on factors such as the location and complexity of the fistula, as well as the patient’s overall health. Common procedures include:
  • Fistulotomy: This involves cutting open the entire length of the fistula tract to allow it to heal from the inside out.
  • Seton placement: A seton is a piece of material (usually surgical thread or rubber band) that is placed through the fistula tract to keep it open and allow drainage. This may be used as a temporary measure or as part of a staged procedure.
  • Fistula plug: A biologic material, such as a collagen plug, is inserted into the fistula tract to help it heal. This technique is typically used for simple, low-lying fistulas.
  • Advancement flap repair: A flap of tissue from the rectal wall is used to cover the internal opening of the fistula, allowing it to heal without leaving an open wound.
• Post-operative Care: After surgery, patients are typically monitored closely for any signs of complications such as infection or bleeding. Pain management and proper wound care are essential during the recovery period.
• Follow-up: Patients will need to follow up with their healthcare provider for regular check-ups to monitor the healing process and address any concerns or complications that may arise.

Anal Fistulae can present with many different symptoms

• Pain
• Discharge – either bloody or purulent
• Pruritus ani-itching

Diagnosis is by examination, either in an outpatient setting or under anesthesia.

• The opening of the fistula onto the skin may be seen
• The area may be painful on examination
• There may be redness
• An area of induration may be felt – thickening due to chronic infection
• A discharge may be seen

It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both opening of the fistula.

• Q: What causes anal fistulas? A: Anal fistulas are often caused by infections in the anal glands or glands near the anus. These infections can lead to the formation of a tunnel (fistula) between the anal canal and the skin around the anus.
• Q: Is surgery the only treatment option for anal fistulas? A: Surgery is often recommended for anal fistulas, particularly those that are complex or recurrent. However, some simple fistulas may be treated with nonsurgical options such as antibiotics, drainage procedures, or medications to manage symptoms.
• Q: What are the different surgical techniques used to treat anal fistulas? A: Surgical techniques for anal fistula treatment include fistulotomy, fistulectomy, seton placement, advancement flap repair, and LIFT (ligation of the intersphincteric fistula tract) procedure. The choice of technique depends on factors such as the location and complexity of the fistula.
• Q: How long does it take to recover from anal fistula surgery? A: Recovery time can vary depending on the type of surgery performed, the individual’s overall health, and the complexity of the fistula. In general, most people can expect to return to normal activities within a few weeks to a few months after surgery.
• Q: What are the risks associated with anal fistula surgery? A: Risks of anal fistula surgery may include infection, bleeding, incontinence (difficulty controlling bowel movements), recurrence of the fistula, and damage to surrounding structures such as nerves or muscles. However, these risks are relatively low, and complications can often be managed effectively.
• Q: Can anal fistulas come back after surgery? A: While surgery aims to remove the fistula tract completely, there is a risk of recurrence, particularly with complex or recurrent fistulas. However, the likelihood of recurrence can be minimized by choosing the appropriate surgical technique and following postoperative care instructions.
• Q: Will I need to make any lifestyle changes after anal fistula surgery? A: In some cases, making certain lifestyle changes such as maintaining good hygiene, avoiding constipation, and adopting a high-fiber diet may help prevent recurrence and promote healing after surgery. Your healthcare provider can provide specific recommendations based on your individual needs.